胸腔积液ADA值在结核性胸膜炎中的诊断价值及临界值探讨

The diagnosis utility of ADA activity in tuberculous pleurisy and investigation of its threshold

目的探讨腺苷脱氨酶(ADA)在鉴别结核性胸腔积液及恶性胸腔积液中的价值,进而分析性别、年龄对结核性胸腔积液ADA值的影响,探讨诊断结核性胸膜炎的最佳ADA临界值。方法对确诊为结核性胸腔积液和恶性胸腔积液305例患者的胸腔积液ADA值及其影响因素(性别、年龄)进行回顾性分析,利用ROC曲线探讨胸腔积液ADA诊断结核性胸膜炎的最佳临界值。结果结核性胸腔积液ADA活性为(42.68±15.69)IU/L,而恶性胸腔积液为(12.69±8.75)IU/L,两者差异有统计学意义(P<0.01);而性别和不同年龄段的结核性胸腔积液ADA活性之间差异无统计学意义(P>0.05);将ADA值设定为23.3IU/L时,其诊断结核性胸膜炎的灵敏度和特异度分别为94.8%和92.8%。结论胸腔积液ADA值可以作为鉴别结核性胸腔积液与恶性胸腔积液的重要指标,且将ADA值设定为23.3IU/L时,诊断结核性胸膜炎效果最佳。

Objective To investigate：1）the ADA value in differential diagnosis of hydrothorax and tuberculous pleurisy;2）the influences of gender and age on the ADA of hydrothorax;3）the best ADA threshold of tuberculous pleurisy.Methods A retrospective analysis was performed with ADA values and its influence factors in 136 cases of tuberculous pleurisy and 169 cases of malignant hydrothorax.The best threshold of diagnosing tuberculous pleurisy with ADA was determined by ROC curve.Results The activity of ADA is（42.68±15.69）IU/L in tuberculous hydrothorax,which was higher than（12.69±8.75）IU/L in malignant hydrothorax with statistical difference（P0.01）.But the activity of ADA in groups of different gender and age did not have significant difference（P0.05）.The critical value of ADA was 23.3 IU/L in diagnosis of tuberculous pleurisy;its corresponding sensitivity and specificity were 94.8% and 92.8% respectively.Conclusion The activity of ADA could be wildly used in the differential diagnosis of tuberculous and malignant hydrothorax.And when the ADA was set at 23.3 IU/L,we got the most accurate diagnose of tuberculous pleurisy.